Angina inestable: ¿manejo invasivo o conservador? / Unstable angina: invasive or conservative management strategy?

RESUMO

Acute coronary syndromes without ST segment elevation (Non-Q-Infarction and unstable angina) share a common pathophysiology, have no indication of thrombolysis, and should not routinely be catheterized on an emergency basis on admission. They should be put in bed rest, given anti-ischemic medications, aspirin and heparin. The small group of patients that do not stabilize with this medical regimen, should be catheterized, in order to have revascularization if they have the appropriate anatomy. There is nowadays a great controversy in the best management strategy for the larger group of patients that becomes stable after medical treatment installation. The invasive strategy proposes early, routine coronary angiography, and revascularization when anatomy is appropriate. The conservative strategy proposes continued medical treatment with invasive management only indicated by development of spontaneous or inducible ischemia. These two alternative strategies have been tested recently in large, prospective, randomized clinical trials there is not a definitive answer, but the provisional guideline is that both are reasonably safe and effective